Provider Demographics
NPI:1871205179
Name:PUTHUSSERIL, JEFFREY (RN)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:PUTHUSSERIL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11083 SUNDRIFT DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3846
Mailing Address - Country:US
Mailing Address - Phone:941-447-8487
Mailing Address - Fax:
Practice Address - Street 1:11083 SUNDRIFT DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3846
Practice Address - Country:US
Practice Address - Phone:941-447-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9380023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse